Security Social

! Update Form I-*

As the employee, you may change

any of the fields below. Click on the

"i" circle for additional information.

Please click "Continue" to verify the

information on the next page.

I have applied, or plan to apply,

and am waiting to receive a

Social Security Number

Social Security Number *"

Re-Enter SSN * "

First Name * "

Freddy

Last Name * "

Matata

Middle Initial *"

B

Other Last Names Used * "

N/A

Date of Birth * "

#

Address * "

1100 Aldridge way

Apt # *"

N/A

City * "

Lexington

State * "

KY

Zip Code * "

40515

Employee's Telephone Number * "

859-***-****

Employee's Email Address * "

adx9fj@r.postjobfree.com

I am aware that federal law provides

for imprisonment and/or fines for

false statements or use of false

documents in connection with

completion of this form.

I attest, under penalty of perjury,

that I am (check one of the

following):

A citizen of the United States

A noncitizen national of the United

States "

A lawful permanent resident "

Alien Registration # / USCIS # "

242039659

An alien authorized to work "

!'# +$

11/15/1986

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